Nâng cao hiệu quả điều trị và giảm tái nhập viện ở người bệnh suy tim mạn vai trò của đơn vị suy tim

Hội nghị Tim mạch Toàn quốc - Hà nội - 10/2016 Vietnam National Heart Association Congress of Cardiology Nâng cao hiệu điều trị giảm tái nhập viện người bệnh suy tim mạn: Vai trò đơn vị suy tim Improve treatment effectiveness and reduce readmisseion of chronic heart failure: Roles of Heart Failure Clinic TS NGUYỄN THỊ THU HOÀI VIỆN TIM MẠCH QUỐC GIA VIỆT NAM Epidemiology of Heart Failure in US Heart Disease and Stroke Statistics - 2016 Update Heart failure mentioned on of death certificates Circulation 2015;132 Epidemiology of Heart Failure in US Heart Disease and Stroke Statistics 2016 Update Treatment costs exceed $30 billion Circulation 2015;132 3500 Trends of absolute numbers of heart failure and CVD patients at Vietnam National Heart Institute 3000 2500 1900 2000 1500 1914 1962 1766 1416 1000 500 2003 2005 2004 2006 2007 Heart Failure Hypertension Ischemic heart disease Rheumatic heart disease Congenital heart desease Pericardial disease Arrhythmia Cardiomyopathies Endocarditis Cerebrovascular disease PAD DVT Systolic versus Diastolic Heart Failure HFREF versus HFPEF Proposed Definitions • • • • Systolic Heart Failure Clinical signs and symptoms – dyspnea, edema, fatigue CXR – pulmonary congestion Typical clinical response to treatment Reduced systolic function: EF < 0.50 • • • • • Diastolic Heart Failure Clinical signs and symptoms - dyspnea, edema, fatigue CXR – pulmonary congestion Typical clinical response to treatment LV EF > 0.50 Diastolic dysfunction by cath LVEDP Circulation 2000;101:2118-2121 Evolving Models of Heart Failure Evolving Models of Heart Failure Genetic Therapies to Neurohormonal modulate Hemodynamic ACE inhibitors, apoptosis, Vasodilators or beta blockers, and Cardiorenal fibrosis, positive inotropes other agents to block remodeling, Digitalis and to relieve ventricular neurohormonal diuretic to arrhythmic wall stress activation perfuse kidneys substrates 1940s 1940s Pepper, Arch Intern Med 1999 1960s 1960s 1970s 1970s 1990s–2000 1990s–2000 Future Future Circula( on + A B C1 C2 P Self-care is very important! After discharge, patients “know” Low salt diet Fluid restriction BUT - Do we accurately intergrate this “know how” in to their REAL LIFE PRACTICE? - After discharge, patients not understand how to adequately take care of themselves SET UP Education program “one to one” interaction Goal Rise awareness of heart failure Strategy to activate motivation Demonstrate a future for them Help patients understand their disease severity Turn the hospitalization time into a self-care training course Educating self-care to HF patients Measure BP, HR, record I/O Measure body weight and maintain safe body weight Low salt diet, limit water intake Know when to report a worsening of disease Differentiate between HF medication types, know when to use diuretics Maintain prescribed exercise and routin clinic visits Team work As long as there is a team, does the team work? How to make it work? Art of orchestrating For example: HF patient with EF 30% Nutritionist visiting: How to make it successful? Other team member function: How to make it successful? Exercise is great medicine but can sometimes be a hard pill to swallow Exercise Program Suggestions for CHF Patients • Graded exercise test – Determine exercise capacity – Evaluate heart rate, blood pressure responses – Assess symptoms Exercise Program Suggestions for CHF Patients • Supervised cardiac rehabilitation program versus unsupervised setting (CHF not a covered diagnosis for CR in US, but many private insurances cover it) • Intensity: moderate; 60% to 80% of VO2peak; HRR; RPE 12-14 • Interval training to optimize results Exercise Prescription in CHF • Daily patient assessment (decompensation) – – – – Rapid weight gain Decreased BP Increased symptoms Increased arrhythmia Conclusions • Heart failure is a largely preventable disease: CAD, BP • Secondary prevention of heart failure mortality and morbidity is effective • • • • Lifestyle modifications Guideline Directed Medical Therapy (GDMT) Defibrillators in selected cases Cardiac resynchronization therapy • End stage treatments: VAD and transplant • Partnership: primary care and cardiology • Cooperative heart failure care unit plays important roles THANK YOU VERY MUCH! ... Improved pumping efficiency Conduction block Stimulation therapy Kass D New dimensions in device-based therapy for heart failure–mechanisms of stimulation for heart failure Heart Failure Society... Demonstrate a future for them Help patients understand their disease severity Turn the hospitalization time into a self-care training course Educating self-care to HF patients Measure BP, HR, record... successful? Other team member function: How to make it successful? Exercise is great medicine but can sometimes be a hard pill to swallow Exercise Program Suggestions for CHF Patients • Graded exercise